Treatment of
hydrocephalus at the
Wessex Neurological
Centre
Mr Ryan Waters
PhD FRCS (Neuro Surg)
Consultant Neurosurgeon
Philosophy
• To provide the highest quality service
– Outcomes
– Patient experience
• Collaborative approach
– Network partnerships with;
• Our referring Trusts
• Oxford Children’s Hospital (Children’s Hospital
Network)
– Third largest unit in the UK
Southampton Staff
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Owen Sparrow
Nijaguna Mathad
Aabir Chakraborty
Ryan Waters
Christine Ward (Nurse practitioner)
13 Paediatric Neurosciences nurses
Peter Gladwell (Surgical Practitioner)
Hydrocephalus
• “An abnormal accumulation of cerebrospinal
fluid (CSF) in the ventricles of the brain”
• but not the whole story?
Classification
• Non-communicating/obstructive
– CSF flow obstruction
– Aqueduct stenosis
– Tumour
– Haemorrhage
• Communicating
– Absorption problem
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Haemorrhage
Infection
Tumour
Inflammation
– ‘normal pressure hydrocephalus’
– IIH
Common causes of hydrocephalus
Causes
Post head injury
Tumour
• Is the child Unwell?
– Vomiting
– Drowsiness
– Headaches
– School performance
– Head circumference
– Fontanelle
– Bradycardia/apnoeas
– Squint
– Sunsetting
Treatment options
• Treat the underlying cause
• Temporary CSF drainage
– Lumbar puncture
– Ventricular tap
– EVD
• Endoscopic IIIrd ventriculostomy
• Shunt
– VP
– VA
– VPleural
ETV
Shunt
Shunt hardware
• Antibiotic impregnated catheters
– Bactiseal
– Silverline
• More than 20 studies on Bactiseal
– Some evidence that Bactiseal reduces
shunt infections
– Need for a multicentre randomised
controlled study - BASICS
Shunt Blockage
Southampton Children's Hospital
Shunt Disconnection
Southampton Children's Hospital
Southampton Children's Hospital
Diagnostic Shunt Tap
• Aseptic Technique
• Measure Opening
Pressure
• If Possible Remove
Adequate Volume of
CSF
• Send Specimens to
Chem, Micro & Culture
NB Facilitated by System
with Reservoir
Southampton Children's Hospital
Normal Pressure Hydrocephalus
• Generally seen in older adults
• Communicating hydrocephalus
• Clinical triad
– Cognitive decline
– Gait disturbance
– Urinary incontinence
• Ventriculomegaly on imaging
Investigation at WNC
• MDT with neurology, neuropsychology,
neurosurgery
• Assessment
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Neuropsychology
Walking test
CSF infusion test
CSF drainage
Treatment at WNC
• VP shunt
– Programmable valve
– Risk of overdrainage and subdural formation
Idiopathic Intracranial Hypertension
• Not ‘hydrocephalus’ but often treated with a
shunt
– A venous disorder
• Multidisciplinary approach; neurology,
neurosurgery and neuroradiology
– Venography, manometry and stenting where
possible
– but shunts still used to control ICP